MRI and Nanoknife/IRE treatment for Prostate Cancer in San Diego

“Living better in San Diego” interviewed Dr. Ross Schwartzberg on the topic of Prostate Cancer. You can listen the to the interview by clicking on the attached link.

The main points of the interview are:

Dr. Schwartzberg and Dr. Cooper are radiologists that have established a new clinic in San Diego for the treatment of prostate cancer. The clinic was originally called the Prostate Center of San Diego and is now called Vitus Prostate Center. Dr. Schwartzberg set up the clinic in conjunction with Dr. Michael Stehling who is based in Offenbach in Germany. Dr Stehling is an interventional radiologist and is the world’s leading expert in a new form of prostate cancer treatment known as NanoKnife or IRE

The development of the new clinic grew of out of Dr. Schwartzberg’s interest and work in the area of imaging for prostate cancer or MRI.

So, what is the prostate? He explains that the prostate is a reproductive organ that sits between the rectum and the bladder. As men get older the prostate gets larger in 60-70% of men and about 17% or 1 in 6 men will be diagnosed with prostate cancer.

Dr. Schwartzberg talks about PSA screening for Prostate Cancer. He explains that PSA (prostate specific antigen) is a protein that is produced by the prostate. It was adopted in the early 90’s as the standard screening test for prostate cancer. However, the PSA test is now one of the most controversial topics in medicine today. The reason for the question marks about PSA is the level of false positives it produces leading to many patients being treated unnecessarily and these treatments have side effects. 7-8 men with elevated PSA levels do not have prostate cancer. The elevated PSA level may be caused by an enlarged healthy prostate or a perineal trauma which could be caused by too much cycling! A very large prostate will produce high levels of PSA but it does not mean that you have cancer.  Prostate MRI has been proven to be an accurate triage tool to be used to determine if a man with elevated PSA needs to proceed to prostate biopsy, and serves to guide the placement of the biopsy needles.

PSA screening is important in certain higher risk cases however. Family history is a strong predictor of prostate cancer. So, if your father died of prostate of prostate cancer there is a far higher chance that you will get prostate cancer. Men of African and Caribbean descent have a far higher (2.5 times higher) probability of getting prostate cancer. So early PSA screening – as early as 45 – is appropriate for these men.

Dr. Schwartzberg explains that prostate cancer falls into two broad categories – low risk cancers and high grade aggressive cancers. Men can live with low risk cancers and manage the cancer by taking an active surveillance approach without intervention. In fact, many men grow old and die with their low risk prostate cancer but not from their prostate cancer. Fortunately, aggressive cancers are less frequent than low risk cancers. In fact, 17% of men will be diagnosed with prostate cancer but only 3% of men will die from the cancer. Unfortunately, it is hard to tell the difference between low risk and aggressive cancers due to the limitations PSA and “blind biopsies” (biopsies that are not guided by imaging) which until now has been the standard approach to diagnosis. PSA levels are measured in a blood test so give no indication where in the prostate the cancer might be. Obviously, the important cancers to identify are the high grade aggressive cancers.

High grade imaging or MRI is a major improvement on the PSA + Blind Biopsy approach to prostate cancer diagnosis. MRI produces detailed images of the entire prostate gland and allows radiologists to detect and localise the cancer and the treatment. In layman’s language Dr. Schwartzberg says that MRI allows us “to look before we poke”. He goes on to say that “we can now see the cancer in the gland”

The advantages of using MRI for diagnosing prostate cancer are significant to all men; to men in high risk categories e.g. Black men – MRI can be used to target the biopsy to provide early and accurate diagnosis of the cancer; in men with elevated PSA and subsequent negative MRI (no target or index lesion)biopsy may be avoided with extremely low risk that a clinically significant cancer has been missed.

MRI is a major step forward for prostate cancer diagnosis and also provides critical information for deciding on the most suitable treatment pathway for men with prostate cancer. Dr. Schwartzberg explained that he got into the area of prostate cancer treatment through his work and interest in imaging which allows us to see the prostate cancer clearly.

The second and equally important news for prostate cancer patients is a new treatment called NanoKnife or IRE (Irreversible electroporation) which builds on the accurate identification of the cancer cells by MRI.

NanoKnife is a non-invasive focal therapy that removes the cancer but not the gland. It uses electrical pulses to kill the tumor without damaging the areas surrounding the prostate. Dr. Schwartzberg has partnered with Professor Michael Stehling who is the world’s leading expert in NanoKnife/ IRE.

At first NanoKnife/ IRE was thought only to be effective for low grade prostate cancer. Dr Stehling has proven in the Vitus Prostate Center in Offenbach in Germany that NanoKnife is extraordinarily effective for patients who have had failed prostate cancer treatment. The reason this works is that NanoKnife is a non-surgical procedure so unlike other surgical procedures that leave scar tissue NanoKnife can be repeated several times if necessary. This is a major advantage because prostate cancer returns in about 10% of all prostate cancer patients.

The success rate in terms of eliminating cancer is tracking similar to conventional radical treatments e.g. prostatectomy. The compelling advantage of NanoKnife/IRE over other treatments is that it reduces the side effects of prostate cancer treatment i.e. it reduces the risk of incontinence to zero and markedly decreased risk of impotence  (below 20%).

NanoKnife/Ire is the next generation of prostate cancer treatment because it treats the identifiable tumor and preserves the rest of the gland. This is exactly the same approach that is used for the modern treatment of breast cancer. In the old days radical treatment of breast cancer was normal – today surgeons just remove the tumour and preserve the rest of the gland.

NanoKnife/ Ire is essentially a pain free procedure. It involves a two-hour procedure where needles are used to piece the skin. Electric pulses are passed surrounding the cancer cells. The cells are damaged irreversibly and die. The procedure is performed in outpatient facility and patients may be discharged  after patient recovers from the effects of the anesthestic.

The combination of MRI and NanoKnife/IRE really is major step forward for prostate cancer treatment and is now available at the Vitus Prostate Center in San Diego.